Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction

Abstract

Background Heart failure ( HF ) with reduced ejection fraction ( rEF ) is a widely regarded prognosticator after coronary artery bypass grafting. HF with preserved ejection fraction ( pEF ) accounts for up to half of all HF cases and is associated with considerable morbidity and mortality in hospitalized cohorts. However, HF p EF outcomes have not been elucidated in cardiac surgical patients. We investigated the prevalence and outcomes of HF p EF and HF r EF in women and men following coronary artery bypass grafting. Methods and Results We conducted a retrospective cohort study in Ontario, Canada, between October 1, 2008, and March 31, 2015, using Cardiac Care Network and Canadian Institute of Health Information data. HF is captured through a validated population‐based database of all Ontarians with physician‐diagnosed HF . We defined pEF as ejection fraction ≥50% and rEF as ejection fraction <50%. The primary outcome was all‐cause mortality. Analyses were stratified by sex. Mortality rates were calculated using Kaplan–Meier method. The relative hazard of death was assessed using multivariable Cox proportional hazard models. Of 40 083 patients (20.6% women), 55.5% had pEF without HF , 25.7% had rEF without HF , 6.9% had HF p EF , and 12.0% had HF r EF . Age‐standardized HF p EF mortality rates at 4±2 years of follow‐up were similar in women and men. HF r EF standardized HF p EF mortality rates were higher in women than men. Conclusions We found a higher prevalence and poorer prognosis of HF p EF in women. A history of HF was a more important prognosticator than ejection fraction. Preoperative screening and extended postoperative follow‐up should be focused on women and men with HF rather than on rEF alone.